Zentralblatt für Chirurgie
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Burn treatment is a complex therapeutic regimen, enclosing immediate resuscitation, burn would care and the complete spectrum of surgical intensive care as well as plastic surgical reconstruction. The pathophysiology of a severe burn injury resembles a maximal trauma response by activating a wide variety of mediators, resulting in a generalized tissue edema (capillary leak). ⋯ Sepsis is still the major mortality factor (75%). Besides established methods like skin culturing, future efforts are directed towards the generation of composite skin grafts and an immunological approach to influence or prevent the course of a burn sepsis.
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Randomized Controlled Trial Clinical Trial
[Hypertonic-hyperoncotic volume replacement (7.5% NaCl/10% hydroxyethyl starch 200.000/0.5) in patients with coronary artery stenoses].
To determine the efficacy and safety of intravascular volume augmentation with a hypertonic saline-hyperoncotic HES solution prior to CABG. ⋯ In patients with coronary artery disease, volume augmentation with hypertonic-hyperoncotic solutions may induce transient hypotension and post-infusion hypervolemic left heart failure.
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The ideal solution for volume therapy is still under discussion. In cardiac surgery, hemodynamic efficacy as well as the influence of cardiopulmonary bypass (CPB) are of major interest when administering volume. Hypertonic sodium (HS) solutions which have been advocated for resuscitation from hemorrhagic shock may also be of benefit in cardiac surgery patients. ⋯ Infusion of HS-HES after weaning from CPB resulted in overall more improved hemodynamics than volume replacement with 6% HES. Rapid infusion of HS-HES during CPB (within 2 min) was followed by a significant, but shortlasting decrease in MAP (-40 mm Hg) and an increase in the oxygenator volume. Preoperative infusion of HS-HES resulted in a significant improvement in skin capillary microcirculation assessed by lased Doppler technique during and after CPB.(ABSTRACT TRUNCATED AT 250 WORDS)
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Laparoscopic surgery may be associated with increased perioperative morbidity due to respiratory and cardiocirculatory problems. Preoperative assessment requires a diagnostic program including laboratory tests and noninvasive diagnostic studies, and a physical status classification. ⋯ Increased intraoperative morbidity is expected in patients with manifest cardiac failure or severely restricted pulmonary function. In patients with moderate pulmonary dysfunction laparoscopic procedures seem to be associated with the benefit of a better postoperative pulmonary function.
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Administration of hypertonic solutions is the method of choice for acute treatment of intracranial hypertension. Recording of the intracranial pressure during treatment facilitates adjustment of the dosis to the actual ICP-response, avoiding thereby administration of an excessive osmotic load as a basis to prolong therapeutical efficacy. The mechanisms underlying reduction of the intracranial pressure by hypertonic solutions are still controversially discussed. ⋯ No evidence has been obtained in a variety of experimental studies that hypertonic/hyperoncotic solutions have adverse effects on the brain in the presence of a cerebral lesion. To the contrary, the fluid mixture has been found to lower the increased intracranial pressure. Administration of hypertonic/hyperoncotic solutions appears therefore appropriate in acute cerebral insults from head injury and impending circulatory failure from shock in order to inhibit development of secondary brain damage.